The Perrin Technique for ME/CFS: Why Your Individual Symptoms Matter

When you live with ME/CFS, explaining how you feel can be surprisingly difficult. You might manage an appointment or a day at work and then need a long period to recover. You may look well to other people while dealing with symptoms that significantly affect what you can do.

This is one of the reasons I don’t approach the Perrin Technique as a fixed routine.

I’ve been working with the Perrin Technique in London for more than 19 years and have treated over 5,000 patients. Over that time, I’ve learned to pay close attention not only to the symptoms someone has, but also to how they respond to everyday demands and what their current level of activity costs them afterwards.

That information matters when deciding how to approach treatment.

Understanding the person behind the symptoms

ME/CFS can affect people in very different ways. Some continue working but have little capacity left for anything else. Others may have to carefully manage even basic daily activities.

The important question isn’t simply, “What can you do?” It is also, “What happens afterwards?”

For example, someone may manage to travel to an appointment but find that the journey has used much of the energy they had available that day. Another person may cope reasonably well during an activity, only to experience a delayed increase in symptoms later.

This is why I ask about the pattern of your symptoms, your daily routine and your recovery after activity. Understanding post-exertional malaise (PEM), where symptoms can worsen following exertion, is particularly important when considering how much a person may comfortably manage.

A brief conversation about fatigue alone would not give me the same picture.

What is the Perrin Technique?

The Perrin Technique is a specialised osteopathic approach developed by Dr Raymond Perrin. It is based on his model of the relationship between the autonomic nervous system and what he describes as neuro-lymphatic drainage.

The approach combines a detailed history and physical assessment with hands-on techniques involving areas such as the back, thoracic spine, ribcage, diaphragm, neck and head, as well as relevant soft tissues and lymphatic pathways. A home programme may also be recommended.

The techniques are intended to support the pathways described in Dr Perrin’s model. The treatment plan is shaped by the clinical assessment and the person receiving it.

For me, understanding how to apply the approach thoughtfully is just as important as knowing the techniques themselves.

What individualised treatment looks like in practice

Adapting treatment isn’t simply a matter of choosing a different technique. It can affect several parts of an appointment.

The pressure and techniques used. I consider how someone presents and what they can comfortably tolerate. The amount of pressure and the areas treated can be adjusted accordingly.

The length of the session. A shorter period of hands-on treatment may be more appropriate than trying to cover too much in one visit. Pauses or changes in position may also help make an appointment more manageable.

The home programme. Self-massage and other home-care suggestions need to fit around someone’s current capacity. That might mean starting with fewer techniques or a simpler programme rather than adding several new tasks at once.

The time between appointments. How someone feels during a session is only part of the picture. It is also useful to understand how they feel afterwards and over the following days. That information helps guide decisions about the next appointment.

These adjustments are not signs that someone is doing treatment incorrectly. They are part of tailoring the approach to the individual.

Why the Perrin-Juhl score is useful

The Perrin-Juhl score is one element of the assessment. It runs from 1 to 10, with 10 representing the best level of health, and considers symptoms, daily function, duration of illness, relevant co-existing conditions and physical examination findings.

I use it to help record a person’s presentation and inform treatment planning. It can also provide a reference point when reviewing how things have changed.

However, no score tells the whole story. I consider it alongside what someone describes, what I find during the examination and how they respond between appointments. It supports clinical judgement; it doesn’t replace it.

What about the first 12 weeks?

Many patients begin with weekly appointments during an initial 12-week assessment period. The continuity can help us observe responses, review the plan and establish whether a suitable home programme can be incorporated into everyday life.

That does not mean everyone should follow the same schedule. The frequency and content of appointments depend on the individual, and the plan should be reviewed in light of their circumstances and response.

Progress is not necessarily a straight line, and a person’s capacity may vary. It is important to discuss changes in symptoms and how you are managing between sessions rather than assume that the same plan will always be appropriate.

Working alongside your existing medical care

People with ME/CFS may already be receiving support from their GP or other healthcare professionals. That care remains important. The Perrin Technique does not replace medical assessment, diagnosis or treatment, and I would encourage you to continue working with your healthcare team.

If symptoms change in a new or concerning way, seek appropriate medical advice rather than assuming the change is related to osteopathic treatment.

My role is to assess whether the approach may be suitable, explain what treatment involves and make decisions with you based on your presentation.

Frequently asked questions

Is the Perrin Technique suitable for everyone with ME/CFS?

Suitability needs to be considered individually. Your medical history, symptoms, examination findings and current circumstances all matter. An initial consultation is an opportunity to discuss whether the approach may be appropriate for you.

Can treatment be adapted if I have very limited energy?

The approach can be adjusted in several ways, including the pressure used, the length of hands-on treatment, pauses, positioning and the amount of home care suggested. It is important to discuss your limitations before and during treatment.

Does a higher Perrin-Juhl score guarantee a particular outcome?

No. The score is a tool for describing the current presentation and supporting planning; it cannot guarantee how someone will respond to treatment.

Should I stop other treatment before starting?

Do not stop prescribed medication or existing medical care on the basis of this article. Discuss any questions about your wider care with the relevant healthcare professional.

Discussing your options

If you are looking for Perrin Technique treatment in London, I’d encourage you to start with a conversation about your own circumstances. Understanding how ME/CFS affects your day-to-day life is an important part of deciding what approach may be suitable.

Written and reviewed by Rakhee Mediratta October 2026: Rakhee has more than 19 years of clinical experience and has treated over 5,000 patients. Her work with the Perrin Technique is guided by detailed assessment and attention to how each person manages their symptoms and everyday activities.